Health Indicator Report of Diabetes Prevalence

Why Is This Important?

Diabetes is a group of diseases characterized by high levels of glucose (a form of sugar) in the blood over a prolonged period. High blood sugar happens when the body cannot produce enough insulin, a hormone that helps lower blood sugar, or when the body cannot use its own insulin properly. Diabetes can lead to serious health complications, such as heart disease, stroke, kidney disease, blindness, leg and feet amputations, and early death.^1^
There are three main types of diabetes, as well as a condition called prediabetes. Type 1 diabetes, in which the pancreas does not produce insulin due to an autoimmune disease, affects about 5% of people with diabetes.^1^
In type 2 diabetes, the pancreas does not produce enough insulin or the body does not use it properly (insulin resistance). Type 2 diabetes is often considered a lifestyle disease because it is normally triggered by living a fairly sedentary life and being overweight. The risk of developing this type of diabetes is associated with aging, obesity, a family history of diabetes, a personal history of gestational diabetes, lack of physical activity, and race and ethnicity. About 90%-95% of all cases of diabetes are type 2 diabetes.^1^
The third type of diabetes is gestational diabetes, which develops only during pregnancy and disappears after the baby is born. However, women who have had gestational diabetes are more likely to have it again in the next pregnancy, and are also at higher risk of developing type 2 diabetes later in life.^2^
Prediabetes, also known as impaired glucose tolerance, is a condition where the blood glucose level is higher than normal, but not high enough to be considered diabetes. People who have prediabetes are at increased risk of developing type 2 diabetes, heart disease, and stroke.
Diabetes has reached epidemic proportions in the United States. According to the Centers for Disease Control and Prevention, the number of Americans with diabetes has increased 50% in the last decade to 30.3 million, or 9.4% of the population. Of the people with diabetes, 7.2 million people, or about one in four, do not know they have it (undiagnosed).^3^ Diabetes takes more lives than AIDS and breast cancer combined, claiming one American every three minutes.^4^
More than 20% of health care spending is for people with diagnosed diabetes.^3^ The estimated total economic cost of diagnosed diabetes in 2012 is $245 billion.^5^
Challenges for diabetes include the risk of complications due to the disease. In order to reduce the burden of disease, we need to identify those at risk, implement effective preventive strategies, and manage metabolic factors known to contribute to diabetes complications.[[br]]
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Chart

Poverty thresholds are intended for use as a statistical yardstick, not as a complete description of what people and families need to live. Poverty thresholds are the dollar amounts assigned by the U.S. Census Bureau to determine poverty status. Poverty thresholds are assigned based upon the size of the family and the ages of the members (i.e., adults versus children). The same thresholds are used throughout the United States. Poverty thresholds were originally derived in the 1963-1964 using U.S. Department of Agriculture food budgets designed for families under economic stress and data about what proportion of their income families spent on food. The thresholds are updated annually for inflation using the Consumer Price Index for All Urban Consumers (CPI-U).
How the Census Bureau Measures Poverty - U.S. Census Bureau [https://www.census.gov/hhes/www/poverty/about/overview/measure.html]

Data Table

Data Notes

Notes

Poverty thresholds computed using the BRFSS assume that householders are less than 65 years of age as the ages of the household heads are not recorded. The maximum of the income range provided for the household is used to evaluate the proportion of the poverty threshold. This is a conservative approach as there are no errors of misclassification into the lowest poverty group. The category of Poor represents less than 100% of the poverty threshold. Near Poor is 100% through 199% of the poverty threshold. Middle/High income families are 200% or higher of the poverty threshold.
How the Census Bureau Measures Poverty - U.S. Census Bureau [https://www.census.gov/hhes/www/poverty/about/overview/measure.html]

Data Interpretation Issues

The [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System (BRFSS)] is the primary source for estimating diabetes prevalence for Alaska. The median of states, District of Columbia, and territories provide a comparison for the United States (U.S.). The BRFSS is a telephone survey of adults 18 and over. Information on background and methodology of the BRFSS managed by the Centers for Disease Control and Prevention (CDC) can be found at: [http://www.cdc.gov/brfss/]. The website for the Alaska BRFSS is: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx].
The question on diabetes has been asked on the standard BRFSS (1991 onward) as well as the supplemental BRFSS survey since its inception in 2004.
Alaska Native people in analyses of the BRFSS refers to any mention of American Indian or Alaska Native heritage when enumerating racial and ethnic background. Individuals who indicate multiple races including American Indian/Alaska Native are considered Alaska Native in the data. When race and ethnicity are consider concurrently, Hispanic individuals with American Indian/Alaska Native heritage are combined into the Alaska Native (any mention) group and removed from the Hispanic class.
This definition of the Alaska Native group is intended to conform to the eligibility requirements for access to Alaska Native Tribal Health Consortium health care services.
Post-stratification weights were used for Alaska prior to 2006; raking weights were used from 2007 onward. For more on this methodological change see: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/method.aspx].

Health Indicator Definition

Definition

Percentage of adults 18 years of age and older who responded "Yes" on the [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System (BRFSS)] to the question: "Has a doctor, nurse, or other health professional ever told you have diabetes?" Responses of "Yes, but female told only during pregnancy" are not considered as a positive response for having diabetes.

Numerator

Weighted number of adults (18+) who responded "Yes" on the BRFSS to the question: "Has a doctor, nurse, or other health professional ever told you have diabetes?" Responses of "Yes, but female told only during pregnancy" are not considered as a positive response for having diabetes.

Denominator

Weighted number of adults (18+) with complete and valid responses to the question: "Has a doctor, nurse, or other health professional ever told you have diabetes?", excluding those with missing, "Don't know/Not sure", or "Refused" responses.

Current Outlook

How Are We Doing?

The prevalence of diabetes has risen steadily, both nationally and in Alaska. Several factors contribute to the continual climb in diabetes prevalence. Increasing rates of obesity and sedentary lifestyles add to the number of people at risk for developing diabetes, while improvements in medical care mean people with diabetes are living longer. The 1997 change in the key diagnostic criterion (fasting blood glucose >126 mg/dL) contributed to the increased number of people who were clinically diagnosed.^7^
Diabetes prevalence rates from the BRFSS are initially presented for all Alaskans, Alaska Native people, and the median from states, District of Columbia, and territories for all available years. Subsequent analyses by demographic subpopulations (i.e., sex, age, race/ethnicity, ethnicity, marital status, education, employment status, income, and poverty status) are limited to 2010 and later to allow for ease of assessing recent trends. Diabetes prevalence increases with increasing age. Non-Hispanic Blacks experienced higher rates of diabetes when compared to Alaska Native people and Whites. People who were unable to work reported higher rates of diabetes compared to those who were employed, unemployed, or not in the work force.
Crosstabulations were also conducted for three-year averages by body mass index, current smoking, sexual orientation, and disability. Only the significant differences evident in contrasts by body mass index and disability are presented but the other results are available upon request.
Diabetes prevalence by regions of Alaska are presented for the most recent time period allowing reporting for all Alaskans and Alaska Native people: 1) single-year for the 6 Alaska Public Health Regions, 2) three-year averages by the 7 Metropolitan and Micropolitan Statistics Areas and rural remainder, 3) single-year for the 10 behavioral health assessment regions based upon aggregations of 20,000 population, 4) three-year averages for 29 boroughs and census areas, and 5) five-year averages for the 12 tribal health organization regions. These time intervals match those for the InstantAtlas health profiles for each of the geographic regions of Alaska, for those desiring longer time series.

How Do We Compare With the U.S.?

The percentage of adults with diabetes in Alaska is lower than that for the United States. In Alaska, the crude rate of adults diagnosed with diabetes was 8.1% for 2017. For the United States, the crude prevalence was 10.5% in 2017.
The percentage of adults with diabetes increases with age, reaching a high of 25.2% in Americans aged 65 or older. There is little gender difference in the prevalence of diagnosed and undiagnosed diabetes in U.S. adults aged 18 or older, with men at 12.7% and women at 11.7%.^3^

Health Improvement Resources

What Is Being Done?

The [http://dhss.alaska.gov/dph/chronic/pages/diabetes/default.aspx Alaska Diabetes Prevention and Control Program (DPCP)] works to increase public awareness of the warning signs, symptoms, and risk factors for developing diabetes. The program seeks innovative ways to encourage people to recognize that they may be at risk and should get tested.
The program promotes glycated hemoglobin (a form of hemoglobin that is measured primarily to identify the average plasma glucose concentration over prolonged periods) awareness through A1C testing among people already diagnosed with diabetes, and has produced television and radio public service announcements stressing the urgency of getting A1C levels under control.
The DPCP, in conjunction with the Alaska Health Plan Partnership, has also developed and distributed materials that remind Alaskans with diabetes of the importance of managing their ABCs (A1C, blood pressure, cholesterol levels, and stop smoking or don't start).
The program assists community-based organizations as they work to increase awareness of diabetes and its risk factors among members of their population. The DPCP has established partnerships with Southcentral Foundation, the Alaska Native Tribal Health Consortium, YMCA, the UAF Cooperative Extension Service, and Bartlett Regional Hospital, to name a few.
The DPCP strongly encourages diabetes self-management education (DSME) for persons with diabetes from an [http://www.diabetes.org/ American Diabetes Association (ADA)] recognized or [https://www.diabeteseducator.org/ American Association of Diabetes Educators (AADE)] accredited program. Diabetes prevention programs are also encouraged for those with prediabetes. DSME is recommended by the 2015 U.S. Preventive Services Task Force (USPSTF) Clinical Guidelines.^8^
For more information about DSME or diabetes prevention program classes near you, contact DPCP at [http://www.diabetes.alaska.gov].

Evidence-based Practices

The National Diabetes Prevention Program (National DPP) showed that weight loss and participation in regular physical activity can significantly decrease the risk of developing type 2 diabetes. The DPP clinical trial included over 3,000 people who had impaired fasting glucose and were at an increased risk for developing diabetes. Participants who engaged in moderately intense physical activity for 30 minutes per day and lost 5% to 7% of their body weight decreased their risk of diabetes dramatically. This behavioral activity was effective for all groups of participants in the study, regardless of age or ethnic group.^9^

The information provided above is from the Alaska Department of
Health and Social Services' Center for Health Data and Statistics,
Alaska Indicator-Based Information System for Public Health (Ak-IBIS)
web site (http://ibis.dhss.alaska.gov). The information published
on this website may be reproduced without permission. Please use
the following citation:
"
Retrieved
Thu, 21 March 2019
from Alaska Department of Health and Social Services, Center for
Health Data and Statistics, Alaska Indicator-Based Information
System for Public Health web site: http://ibis.dhss.alaska.gov
".

Content updated: Tue, 15 Jan 2019 14:20:40 AKST

The information provided above is from the Alaska Department of Health and Social Services' Center for Health Data and Statistics AK-IBIS web site (http://ibis.dhss.alaska.gov/). The information published
on this website may be reproduced without permission. Please use the following citation:
"
Retrieved
Thu, 21 March 2019 12:18:30
from Alaska Department of Health and Social Services, Center for Health Data and Statistics, Indicator-Based Information
System for Public Health Web site: http://ibis.dhss.alaska.gov/
".